药物联合生物反馈治疗功能性肠胃疾病的临床疗效分析

目的：观察探讨生物反馈疗法联合药物治疗功能性胃肠疾病患者的临床效果. 方法：选取2012年8月至2013年10月来我院就诊并确诊的功能性肠胃病患者220例作为研究对象,随机分为观察组（110例）和对照组（110例）.观察组患者采用常规药物联合生物反馈疗法,对照组患者采用常规药物治疗,比较两种方法的治疗效果.结果：治疗后,观察组有效率为95.45%,高于对照组86.36%（P〈0.05）;且观察组患者平均疗效好于对照组（P﹤ 0.05）.结论：采用药物联合生物反馈疗法治疗功能性胃肠疾病患者能明显改善其临床症状,具有较好的治疗效果,且安全简便,值得临床推广.

试论心理因素对功能性胃肠疾病的影响

随着科学技术的快速发展,社会竞争的日趋激烈,与心理因素密切相关的疾病的发病率明显增加。最易受情绪和外部环境影响的消化系统是心身相关最敏感的器官,同时发病率也是内科心身疾病中最高的。功能性胃肠疾病(FGID)的发病与病人的精神状态、应激因素有密切的关系,性格异常、过分焦虑的人发病率明显高于正常人。因此,本文就心理因素在FGID的发病中的作用进行研究。

Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)

AIM： To investigate the role of wireless capsule endoscopy （WCE） in detection of small bowel （SB） pathology in patients with chronic renal failure （CRF） and obscure bleeding. METHODS： Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results. RESULTS： Seventeen CRF patients （11 overt, 6 occult bleeding） and 51 patients （33 overt, 18 occult bleeding） with normal renal function were enrolled in this study. Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients （P〈0.05）. SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia （P〈0.05）. Therapeutic measures were undertaken in 66% of the patients with the positive findings. CONCLUSION： According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.

Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome?

AIM To evaluate the prevalence of nodular lymphoid hyperplasia(NLH) in adult patients undergoing colonoscopy and its association with known diseases. METHODS We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome(IBS)-type symptoms or suspected inflammatory bowel disease(IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening.Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.RESULTS One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals(only 3%), while it was significantly more prevalent in symptomatic cases(32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis. CONCLUSION About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.

Targeting voltage-gated sodium channels for treatment for chronic visceral pain

Voltage-gated sodium channels (VGSCs) play a fundamental role in controlling cellular excitability,and their abnormal activity is related to several pathological processes,including cardiac arrhythmias,epilepsy,neurodegenerative diseases,spasticity and chronic pain.In particular,chronic visceral pain,the central symptom of functional gastrointestinal disorders such as irritable bowel syndrome,is a serious clinical problem that affects a high percentage of the world population.In spite of intense research efforts and after the dedicated decade of pain control and research,there are not many options to treat chronic pain conditions.However,there is a wealth of evidence emerging to give hope that a more refined approach may be achievable.By using electronic databases,available data on structural and functional properties of VGSCs in chronic pain,particularly functional gastrointestinal hypersensitivity,were reviewed.We summarize the involvement and molecular bases of action of VGSCs in the pathophysiology of several organic and functionalgastrointestinal disorders.We also describe the efficacy of VGSC blockers in the treatment of these neurological diseases,and outline future developments that may extend the therapeutic use of compounds that target VGSCs.Overall,clinical and experimental data indicate that isoform-specific blockers of these channels or targeting of their modulators may provide effective and novel approaches for visceral pain therapy.

Irritable bowel syndrome and diet

Irritable bowel syndrome(IBS)is a chronic functional disorder of the gastrointestinal tract and is one of the most commonly diagnosed gastrointestinal diseases.The impact of IBS on the general population is large due to its high prevalence,suboptimal medical treatments and significant economic burden.The pathophysiology of IBS is complex and treatments are often symptom-specific.Themost common therapeutic approaches for IBS include education and reassurance,lifestyles(especially nutrition-based interventions),peripherally acting medications(which typically target motility),centrally actingmedications(which target visceral hypersensitivity and pain)and psychological interventions(which aim to reduce the effects of stress or symptom-specific anxiety).A beneficial dietary approach might include the following measures:a diet low in fermentable oligo-,di-and monosaccharides and polyols(FODMAPs),limitation or exclusion of gas-producing foods and/or lactose and gluten and fiber supplementation in selected cases.New therapeutic agents,namely nutraceutics,are also an interesting option in the management of IBS patients.This paper will focus on available dietary interventions for IBS and will review the evidence for nutrition-based therapies.